Provider Demographics
NPI:1639721954
Name:TOWN OF ORANGE PARK
Entity Type:Organization
Organization Name:TOWN OF ORANGE PARK
Other - Org Name:ORANGE PARK FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONTESTABILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-278-2083
Mailing Address - Street 1:PO BOX 161993
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1993
Mailing Address - Country:US
Mailing Address - Phone:904-264-3411
Mailing Address - Fax:
Practice Address - Street 1:2025 SMITH ST
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5579
Practice Address - Country:US
Practice Address - Phone:904-264-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104429700Medicaid
FLP02315588OtherRAIL ROAD